Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
BMJ Open. 2022 May 4;12(5):e055483. doi: 10.1136/bmjopen-2021-055483.
Indonesia implemented its first e-cigarette regulation in 2018, a 57% tax on the retail price of e-cigarette liquid (e-liquid), exceeding the 40% average tax on cigarettes. Economic research suggests that this tax could unintentionally increase cigarette smoking among dual users, but this has not been examined in a low-income or middle-income country. We therefore investigated the effects of the e-liquid tax among adults in Indonesia.
Pre-post study.
Indonesia.
Adults who currently used e-cigarettes and either currently or occasionally smoked cigarettes or recently quit were recruited using Facebook and Instagram ads. Our follow-up response rate was 79%. A final sample of 1039 adults participated.
E-cigarette and cigarette use.
Following the e-liquid tax, participants reported paying a 4.4% higher price for e-liquid (p=0.02). Participants also reported an average 0.5-day decrease in the number of days they used e-cigarettes in the past week (p<0.001), and the proportion of daily e-cigarette users decreased (75.9% to 63.6%; p<0.001). Overall, reported use of cigarettes also declined, on average, by nine cigarettes per week. Participants who reported decreasing their e-cigarette use had higher odds of reporting increasing their cigarette use rather than reporting no change (adjusted OR: 2.99; 95% CI: 1.95 to 4.59). Further, as participants reported using e-cigarettes less frequently, they reported using cigarettes more frequently (β=-2.41, p=0.007).
Following an e-liquid tax in Indonesia, prices of e-liquid increased slightly, e-cigarette and cigarette use declined, and people who reported decreasing their e-cigarette use reported increasing their cigarette use. To avoid encouraging cigarette use, a prudent approach would be to raise cigarette taxes concurrently with e-cigarette taxes.
印度尼西亚于 2018 年实施了首个电子烟监管规定，对电子烟液（e-liquid）的零售价征收 57%的税，超过了 40%的香烟平均税率。经济研究表明，这一税收可能会在无意中增加双重使用者的吸烟量，但在低收入或中等收入国家，这一点尚未得到检验。因此，我们调查了印度尼西亚成年人中电子烟液税的影响。
前后研究。
印度尼西亚。
目前使用电子烟且目前或偶尔吸烟或最近戒烟的成年人通过 Facebook 和 Instagram 广告招募。我们的后续回复率为 79%。最终有 1039 名成年人参与了研究。
电子烟和香烟使用情况。
在电子烟液税实施后，参与者报告电子烟液的价格上涨了 4.4%（p=0.02）。参与者还报告称，过去一周使用电子烟的天数平均减少了 0.5 天（p<0.001），并且每天使用电子烟的人数比例下降（75.9%降至 63.6%；p<0.001）。总体而言，报告的香烟使用量平均每周减少了 9 支。报告减少电子烟使用量的参与者更有可能报告增加香烟使用量，而不是报告没有变化（调整后的比值比：2.99；95%置信区间：1.95 至 4.59）。此外，随着参与者报告使用电子烟的频率降低，他们报告使用香烟的频率增加（β=-2.41，p=0.007）。
在印度尼西亚征收电子烟液税后，电子烟液价格略有上涨，电子烟和香烟使用量下降，报告减少电子烟使用量的人报告增加了香烟使用量。为避免鼓励吸烟，谨慎的做法是在征收电子烟税的同时提高香烟税。
